Consciousness in non-epileptic attack disorder

Non-epileptic attack disorder (NEAD) is one of the most important differential diagnoses of epilepsy. Impairment of consciousness is the key feature of non-epileptic attacks (NEAs). The first half of this review summarises the clinical research literature featuring observations relating to consciousness in NEAD. The second half places this evidence in the wider context of the recent discourse on consciousness in neuroscience and the philosophy of mind. We argue that studies of consciousness should not only distinguish between the ‘level’ and ‘content’ of consciousness but also between ‘phenomenal consciousness’ (consciousness of states it somehow “feels to be like”) and ‘access consciousness’ (having certain ‘higher’ cognitive processes at one’s disposal). The existing evidence shows that there is a great intra- and interindividual variability of NEA experience. However, in most NEAs phenomenal experience – and, as a precondition for that experience, vigilance or wakefulness – is reduced to a lesser degree than in those epileptic seizures involving impairment of consciousness. In fact, complete loss of “consciousness” is the exception rather than the rule in NEAs. Patients, as well as external observers, may have a tendency to overestimate impairments of consciousness during the seizures

What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies.

PURPOSE: This is a narrative systematic synthesis of qualitative research investigating patients' accounts of living with psychogenic nonepileptic seizures (PNES). Qualitative methodologies allow patients to share lived experiences in their own words. The examination of patients' own accounts is likely to offer revealing insights into a poorly understood, heterogeneous disorder. METHODS: We identified 21 separate studies about PNES published after 1996 and based on analyses of patients' own words. Papers were synthesised inductively and deductively using an iterative approach. RESULTS: Five key themes emerged from the synthesis of studies capturing accounts from over 220 patients, reflecting experiences of seizure events, diagnosis, treatment and management, emotional events, and impact on daily life. Patients with PNES discussed the phenomenology of their seizures differently from those with epilepsy. PNES were experientially heterogeneous. Many patients shared a sense of uncertainty surrounding PNES, often resisting psychological explanations. Negative experiences with healthcare professionals were common. Patients seeking validation of their experiences often reported feeling ignored or doubted. Many reported past or current stressful events. Some demonstrated insight into their methods of emotional processing. PNES were described as a significant burden associated with financial and psychosocial losses. CONCLUSIONS: Qualitative studies have produced helpful insights into patients' experiences of living with PNES, but many patient groups (men, young people, elderly, non-Western patients) are underrepresented in studies carried out to date. Research capturing these patient groups and using new methods of data collection and qualitative analysis could help to deepen our understanding of this disorder

Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review

Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients’ lives. Patients, family members, and clinicians have yet to fully understand the mechanisms and treatment of this disorder. Although reviews exist about epileptic seizures, there have been no systematic reviews of studies focusing on the impact of PNES. This review considers research on factors associated with the health-related quality of life (HRQoL) of patients with PNES. Searches of Medline, PsycINFO, CINAHL, and Cochrane Library were conducted. Search terms identified studies that examined factors associated with HRQoL in PNES. Factors fell into three categories: (1) seizure and somatic factors, (2) psychological factors, and (3) coping strategies and family functioning. Fourteen articles were included. The majority of studies were cross-sectional and were of weak to moderate quality. Depressive symptoms were negatively associated with HRQoL. Other factors associated with poorer HRQoL included dissociation, somatic symptoms, escape-avoidance coping strategies, and family dysfunction. Variables such as seizure frequency and demographic factors were not significantly associated with HRQoL. Psychological and interpersonal factors, not seizure reduction, are important for the HRQoL of patients with PNES. The avoidance of emotions is proposed as a perpetuating factor in the difficulties associated with poorer HRQoL. A biopsychosocial approach has relevance for both the clinical and theoretical understanding of PNES. Larger scale research on psychological and relational factors is needed to inform therapeutic approaches to enhance HRQoL in patients with PNES

Neuroimaging studies in patients with psychogenic non-epileptic seizures: A systematic meta-review

Psychogenic Non-epileptic Seizures (PNES) are ‘medically unexplained’ seizure-like episodes which superficially resemble epileptic seizures but which are not caused by epileptiform discharges in the brain. While many experts see PNES disorder as a multifactorial biopsychosocial condition, little is known about the neurobiological processes which may predispose, precipitate and/or perpetuate PNES symptomology. This systematic meta-review advances our knowledge and understanding of the neurobiological correlates of PNES by providing an up-to-date assessment of neuroimaging studies performed on individuals with PNES. Although the results presented appear inconclusive, they are consistent with an association between structural and functional brain abnormalities and PNES. These findings have implications for the way in which we think about this “medically unexplained” disorder and how we communicate the diagnosis to patients. However, it is also evident that neuroimaging studies in this area suffer from a number of significant limitations and future larger studies will need to better address these if we are to improve our understanding of the neurobiological correlates of predisposition to and/or manifestation of PNES

Written accounts of living With epilepsy or psychogenic nonepileptic seizures: A thematic comparison

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: "Seizure onset" revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: "Emotive tone" demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions), whereas those of writers with PNES reflected anxiety and low mood. Theme 3: "Seizure symptoms" showed differences in the conceptualization of seizures. Theme 4: "Treatment" explored differences in the diagnostic journey and experiences of health care professionals. Theme 5: "Daily life" revealed that those with epilepsy perceived sequelae and seizures as something that must be fought, whereas those with PNES tended to describe their seizures as a place they enter and something that has destroyed their lives. The findings have implications for treatment and management

Diagnosing people with dementia using automatic conversation analysis

A recent study using Conversation Analysis (CA) has demonstrated that communication problems may be picked up during conversations between patients and neurologists, and that this can be used to differentiate between patients with (progressive neurodegenerative dementia) ND and those with (nonprogressive) functional memory disorders (FMD). This paper presents a novel automatic method for transcribing such conversations and extracting CA-style features. A range of acoustic, syntactic, semantic and visual features were automatically extracted and used to train a set of classifiers. In a proof-of-principle style study, using data recording during real neurologist-patient consultations, we demonstrate that automatically extracting CA-style features gives a classification accuracy of 95%when using verbatim transcripts. Replacing those transcripts with automatic speech recognition transcripts, we obtain a classification accuracy of 79% which improves to 90% when feature selection is applied. This is a first and encouraging step towards replacing inaccurate, potentially stressful cognitive tests with a test based on monitoring conversation capabilities that could be conducted in e.g. the privacy of the patient’s own home

Health related quality of life of people with non-epileptic seizures: The role of socio-demographic characteristics and stigma

Purpose People with non-epileptic seizures (NES) consistently report poorer Health-Related Quality of Life (HRQoL) than people with epilepsy. Yet, unlike in epilepsy, knowledge of how social factors influence the HRQoL of adults with NES is limited. To add to the evidence base, this study explores the relationship between HRQoL and perceived stigma among adults with NES, and the role of socio-demographic characteristics. Methods Data was gathered from a survey of 115 people living with the condition, recruited from online support groups. Participants provided socio-demographic and health-related data and completed a series of questions investigating their HRQoL (QOLIE-31) and stigma perceptions (10-item Epilepsy Stigma Scale). Results Participants were found to experience high levels of perceived stigma (median 5.2, mean 4.9). A significant and moderate inverse correlation was observed between HRQoL and stigma (rs − 0.474, p = < 0.001); suggesting higher perceptions of stigma contribute to poorer HRQoL among adults with NES. Stigma perceptions were found to be most strongly associated with the seizure worry (rs = − 0.479), emotional wellbeing (rs = − 0.421), and social functioning (rs = 0.407) HRQoL domains. Participants who reported being in employment or education were found to have significantly better HRQoL than those who were not (p = < 0.001). Conclusion More (qualitative and quantitative) research is justified to understand how – and why – those with the condition experience stigmatisation, and the factors that impede and help facilitate the participation of people with NES in education and employment

A new species of Chaunus from Central Brazil : Anura; Bufonidae

A new species of Chaunus, apparently related to Chaunus arenarum, Chaunus rubescens, and Chaunus achavali is described. The new species occupies Cerrado habitats in southwestern Piauı´ and Bahia states and in northwestern Minas Gerais state, Brazil. The species is characterized by anterior interruption of the supraocular crest; weakly developed cranial crests; short and robust limbs; several pointed spiculae on dorsum, head, and limbs; male coloration; small to medium size; and by the short and narrow head

Role of Hyperon Negative Energy Sea in Nuclear Matter

We have examined the contribution of the filled negative energy sea of hyperons to the energy/particle in nuclear matter at the one and two loop levels. While this has the potential to be significant, we find a strong cancellation between the one and two loop contributions for our chosen parameters so that hyperon effects can be justifiably neglected.Comment: 12 pages, latex, 1 simple figure attached at end (regular postscript